INTERESTING IMAGE

Marked Response to 177Lu Prostate-Specific Membrane Antigen

Treatment in Patient With Metastatic Prostate Cancer
Cigdem Soydal, MD,* Elgin Ozkan, MD,* Serap Akyurek, MD, and Nuriye Ozlem Kucuk, MD*
Abstract: We present pretreatment 68Ga prostate-specific membrane antigen (PSMA) PET/CT and posttreatment 177Lu-PSMA whole-body scintigraphy images of a 60-year-old patient with metastatic prostate cancer who
is dramatically responding to 177Lu-PSMA treatment.
Key Words: 68Ga-PSMA PET/CT, 177Lu-PSMA treatment, prostatic cancer
(Clin Nucl Med 2015;00: 0000)

Received for publication June 29, 2015; revision accepted September 12, 2015.
From the Departments of *Nuclear Medicine and Radiation Oncology, Ankara
University Medical Faculty, Ankara, Turkey.
Conflicts of interest and sources of funding: none declared.
Correspondence to: Cigdem Soydal, MD, Department of Nuclear Medicine,
Ankara University Medical Faculty, 06590, Cebeci, Ankara, Turkey. E-mail:
csoydal@yahoo.com.
Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0363-9762/15/00000000
DOI: 10.1097/RLU.0000000000001058

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Clinical Nuclear Medicine Volume 00, Number 00, Month 2015

Soydal et al

FIGURE 1. A 60-year-old patient with metastatic prostate

cancer who had received hormone therapy following
radical prostatectomy referred for 177Lu prostate-specific
membrane antigen (PSMA) treatment. Pretreatment
whole-body PET/CT imaging was performed approximately
1 hour after an intravenous injection of approximately
100 MBq 68Ga-PSMA with GE Discovery ST PET/CT
scanner (General Electric, Milwaukee, WI). Multiple
pathological uptakes in bone lesions and additionally in
mediastinal lymph nodes were detected.

FIGURE 2. The patient underwent 4 cycles of 7400-MBq 177Lu-PSMA treatment within the dates of January 29, 2015, and
June 25, 2015, between 6-week periods. Twenty-four hours after each treatment, whole-body planar scintigraphic images
were obtained with GE Millenium dual-headed SPECT camera with matrix size of 256  1024 and speed of 6.0 min/m.
In posttreatment scan of the first cycle, intense uptakes in the cranium, vertebral column, costae, pelvic bones, each scapula,
humerus, femur, and mediastinal lymph nodes were confirmed (A). At that time, serum prostate-specific antigen (PSA) level
was measured as 988.2 ng/mL. Interestingly, whole-body scan after the second dose (B) revealed an increase in number and
intensity of pathological uptake areas in axial skeleton and femurs with elevation of serum PSA level (1770 ng/mL). The number
of pathological uptake areas in skeleton dramatically decreased in the third (PSA = 55.95 ng/mL) cycle, and uptake in mediastinal
lymph nodes disappeared (C). After the fourth (PSA = 14.86 ng/mL) cycle, patient bone lesions were almost absent except a few
areas in the costae and thoracic vertebrae (D). Interestingly, the patient experienced gastrointestinal symptoms such as vomiting
and stomachache during the third and fourth cycles. In both whole-body images (C and D), increase in gastrointestinal uptake was
observed. Prostate-specific membrane antigen is a transmembrane cell surface protein expressed in prostate cancer tissue as well
as kidney, salivary glands, and intestinal system.1,2 Prostate-specific membrane antigen has been a subject of interest to bind
different radionuclides for imaging and treatment of metastatic prostatic carcinoma.36 For this reason, second-generation
antibodies have been developed to bind the extracellular domain of PSMA. Radionuclide treatment with 90Y- or 177Lu-labeled
PSMA is a potential method to treat metastatic prostatic carcinoma.7,8 Because the method has recently been developed,
experience on its potential efficacy and adverse effects have not been well known yet. In this case, we noticed there might be a
flair-like effect of treatment that might be a predictor for good response. In addition, decrease in pathological lesions might
be accompanied with increase in gastrointestinal uptake and related adverse effects.
2

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Copyright 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
This paper can be cited using the date of access and the unique DOI number which can be found in the footnotes.